Business Architecture of Hospitals – Part 3

Hospitals are complex organizations and that is mainly because of the complexity of the business. This article elaborates on this topic by focusing on a single element of the hospital business: the dialysis treatment.

Dialysis is needed for end-stage renal disease (ESRD) patients. These patients can only be cured by kidney transplantation or they otherwise need a frequent dialysis that emulates the function of the kidney. Estimations of the ESRD patients fluctuate. The company Rockwellmed that offers dialysis services made a taxation of about 2 million ESRD patients.

The business is concentrated around the required treatment (and previous diagnosis) of these patients. This obviously requires first of all active participation of the patient. Different kinds of treatment (hemio or peritoneal dialysis) require more or less involvement of the patient. This requires information or brochures about the treatment and formal acceptance of the patient.

Then, this business (process) must be organized, and that involves at least the following actions and resources:

  • a medical / nursery assistance
  • space to accommodate the treatment
  • medical equipment
  • medicine
  • information systems to update the treatment with the patient dossier and general clinical databases.

There are a large number of issues that requires a management decision for this specific client group. To name a few issues, just think of the following:

  • Should we execute these treatments in-house or are more specialized centers a better solution for both the client and the hospital?
  • From what kind of supplier do we buy the dialysis equipment or the medicine)?
  • How is the information updated when the treatment is outsourced?

Now, the architectural element lies in the fact that these apparent singular issues are interrelated. Not only amongst them, but also with other issues from other business areas of the hospital. For example: if the treatment is outsourced there is no need of equipment, but there is need of information about the treatment.

Each types of treatment has its own risk-profile and influences the way to organize the activity: “Peritoneal dialysis is typically done in the patients’ home or workplace… has a higher potential for infection. Peritonitis is the most common serious complication…” (

Also important is the relation of these patient groups with other patient groups.

to be continued …

© 2008 Hans Bool

Source by Hans Bool

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